Reversible Cognitive Disorder - Pseudodementia

Carrie Steckl, Ph.D., edited by Natalie Staats Reiss, Ph.D.

A primary reason that accurate diagnosis is so important among people exhibiting cognitive problems is that some causes of cognitive impairment are reversible. Consider the costs - physically, emotionally, and financially - of diagnosing someone with irreversible dementia when, in fact, the problem could have been reversed. Reversible conditions creating cognitive problems include pseudodementia, medical conditions, and delirium.

Pseudodementia

Pseudodementia is a situation where a person who has depression also has cognitive impairment that looks like dementia. Depression is a mental disorder that includes a depressed mood that lasts at least two weeks accompanied by the loss of interest or pleasure in nearly all activities, feelings of guilt or suicidality, social withdrawal, and sleep and appetite disturbances. Depression can also create cognitive symptoms such as difficulty thinking clearly, problems concentrating, and difficulty making decisions. For more detailed information about the symptoms of depression, please click here to visit our associated topic center. Pseudodementia is not permanent; once a person's depression is successfully treated, his or her cognitive symptoms will go away as well.

Diagnosis

Estimates suggest that between 2% and 32% of older individuals who experience cognitive problems actually have pseudodementia. However, this number may not be completely accurate, because it is often tricky to distinguish between depression and dementia in older adults. A thorough clinical interview can reveal important clues about the proper diagnosis. For instance, while people with depression may complain of having memory problems and appear upset about them, they will usually perform well on objective neuropsychological tests of memory administered in a clinician's office. On the other hand, individuals with dementia will often deny having any problems with memory or minimize their importance, and display impairment on neuropsychological tests.

The Geriatric Depression Scale (GDS) (described in an earlier section;click here to return to that discussion) is often used to help differentiate between pseudodementia and other forms of dementia. Results from the GDS are combined other information about a person's history and current functioning to help with diagnosis. For example, people with pseudodementia typically do not have a history of mood swings (unless they have Bipolar Disorder, an illness characterized by repetitive swings in mood and energy levels) and are likely to score high (high = more depressed) on the GDS. In contrast, people with dementia usually show a range of emotions, sometimes responding to situations with an inappropriate emotion (e.g., laughing while others are sad).

Treatment

Although pseudodementia is reversible, treating it can be as complex as treating "regular dementia," requiring a flexible approach and multiple treatment modalities (e.g., medication, psychotherapy, or a combination of both). Depression has multiple potential causes (click here to read more about causes of depression in our related topic center); therefore, which treatments or combinations of treatments will be effective tend to vary across individuals.

Medications to treat depression include monoamine oxidase inhibitors and trycyclics, which make neurotransmitters (chemical messengers in the brain and nervous system) that impact mood such as norepinephrine and serotonin more readily available in the brain. Another class of medications called selective serotonin reuptake inhibitors (e.g., Prozac, Paxil) raises the overall level of the neurotransmitter serotonin. Each of these types of medications has different potential side effects and should be used in consultation with a health care professional who has specific expertise in treating depression.

Psychotherapy involves meeting with a licensed mental health care professional, either individually or in a group, and working on strategies to help manage or reduce depressive symptoms. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are two types of therapies for depression that have been shown to be successful in research studies. CBT involves modifying a person's behavior and thinking patterns that are contributing to a depressed mood. IPT focuses on understanding how personal relationships can cause someone to become depressed or make already existing depressive symptoms worse. For more information about depression and the different treatment options available, please see our related topic center.

Depression is often successfully treated; however, symptoms (including cognitive impairment) typically do not go away immediately. Both medications and psychotherapy techniques may require several weeks before providing a noticeable decrease in symptoms. In addition, people who have depression may experience relapses (i.e., symptoms return). It is important to find a qualified mental health professional to treat and monitor depressive symptoms across time.